Cholesteatoma extending into the sternocleidomastoid muscle presenting as a Bezold abscess

Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.

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Blue Ear Drum and its Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894760850s256 ◽

1976 ◽

Vol 85 (2_suppl) ◽

pp. 293-295 ◽

Cited By ~ 2

Author(s):

Michael M. Paparella

Keyword(s):

Middle Ear ◽

Proper Treatment ◽

Blood Products ◽

Ventilation Tube ◽

Radical Mastoidectomy ◽

Long Period ◽

Modified Radical Mastoidectomy ◽

Ventilation Tubes ◽

Serous Otitis Media ◽

Mastoid Surgery

The “blue ear drum” generally refers to a condition in which blood or blood products are found in the middle ear. After all possible causes for hemotympanum, including blood dyscrasias and trauma are searched for and ruled out, the patient may have chronic serous otitis media accompanied by bloody effusion. Treatment for all of these patients is conservative, consisting of medical therapy and, if need be, myringotomy and insertion of ventilation tubes. In spite of proper treatment, rarely the condition may progress, over a long period of time, to a state of intractability. Characteristic findings are a hypocellular mastoid, hyperplastic and metaplastic mucoperiosteal lining, including the presence of glands and cysts and Cholesterin granuloma. The recommended procedure is a modified radical mastoidectomy, placement of silicone rubber sheeting in the middle ear and insertion of a ventilation tube. It is to be emphasized that mastoid surgery is rarely indicated for these patients and only after all else has failed.

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Bondy's Modified Radical Mastoidectomy Revisited

Ear Nose & Throat Journal ◽

10.1177/014556139407300105 ◽

1994 ◽

Vol 73 (1) ◽

pp. 15-18 ◽

Cited By ~ 3

Author(s):

Dennis G. Pappas

Keyword(s):

Middle Ear ◽

Disease Process ◽

Ossicular Chain ◽

Normal Hearing ◽

The Body ◽

Radical Mastoidectomy ◽

Pars Tensa ◽

Modified Radical Mastoidectomy

The original criteria for modifying a radical mastoidectomy were: (I) an intact pars tensa and a defective pars flaccid a with cholesteatoma; (2) normal or near normal hearing; and (3) an intact, functional ossicular chain. We propose a fourth criterion: that the cholesteatoma site be delineated lateral to the body of the incus. Control of the disease process is easily assured if the lesion is in that area. Our recommended fourth criterion is based on the results of a five-year study of fifty-two cases that met the original criteria. The cholesteatoma reoccurred in the middle ear in only one case. In six cases, periodic care is necessary because of retraction to the grafted attic area. The procedure and technique used in these patients and the excellent results are discussed in this article.

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Fluid Structure Interactions in the Eustachain Tube Under Normal and Pathological Conditions

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-175328 ◽

2007 ◽

Author(s):

Amanda E. Warrick ◽

J. Douglas Swarts ◽

Samir N. Ghadiali

Keyword(s):

Soft Tissue ◽

Cleft Palate ◽

Middle Ear ◽

Psychosocial Development ◽

Hard Palate ◽

Collapsible Tube ◽

Fluid Structure Interactions ◽

Surrounding Soft Tissue ◽

Pathological Conditions ◽

Craniofacial Syndrome

Cleft Palate is a craniofacial syndrome in which the two plates that form the hard palate are not completely joined. As a result, the soft tissue anatomy of the Eustachian Tube (ET) is altered. The ET is a collapsible tube which connects the middle ear (ME) with the nasopharynx (NP). The ET must be periodically opened to equalize ME and NP pressures and drain ME fluids. In healthy adults, ET openings occur during swallowing, where muscle contraction deforms the surrounding soft tissue. However, changes in tissue anatomy may lead to ET dysfunction (i.e. closure during swallowing) and the development of ME disorders such as Otitis Media (OM)[1]. These disorders are especially problematic in infants with cleft palate as they hinder speech, hearing and psychosocial development. Although surgical procedures can be used to repair a cleft palate, these procedures do not typically account the possible development of ET dysfunction and/or OM.

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Effect of Mastoid Cavity Modification on Middle Ear Sound Transmission

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948209100512 ◽

1982 ◽

Vol 91 (5) ◽

pp. 526-532 ◽

Cited By ~ 21

Author(s):

John T. McElveen ◽

Chris Miller ◽

Richard L. Goode ◽

Stephen A. Falk

Keyword(s):

Middle Ear ◽

Computer Model ◽

Sound Transmission ◽

Mastoid Cavity ◽

Canal Wall ◽

Radical Mastoidectomy ◽

Analog Model ◽

Modified Radical Mastoidectomy ◽

Temporal Bones ◽

Intact Canal Wall Mastoidectomy

The modified radical mastoidectomy and intact canal wall mastoidectomy are the two most popular procedures used today for the treatment of chronic middle ear and mastoid disease. Their effects on the anatomy of the middle ear and mastoid cavity are quite different and it might also be expected that they would modify middle ear sound transmission in different ways. This paper describes experiments with human temporal bones and a middle ear computer analog model that attempt to define acoustic differences produced by cavity modifications in these two procedures. The temporal bone studies showed that blocking the aditus (as in modified radical mastoidectomy) produced improved sound transmission in the 1,500- to 4,000-Hz range and decreased transmission below 1,000 Hz when compared to the enlarged aditus and enlarged mastoid condition (as in intact canal wall mastoidectomy). The computer model showed better transmission at all frequencies with the intact canal wall mastoidectomy simulation.

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A STUDY OF RADIOLOGICAL CHANGES IN CSOM AND THEIR CO-RELATION WITH INTRA-OPERATIVE SURGICAL FINDING

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i12.1598 ◽

2020 ◽

Vol 4 (12) ◽

Author(s):

Vishal Hansrajani ◽

Navin Agrawal ◽

Chhavi Agrawal ◽

Kriti Shrivastav ◽

Parul Parmar ◽

...

Keyword(s):

Soft Tissue ◽

Ct Scan ◽

Temporal Bone ◽

Middle Ear ◽

Chronic Otitis Media ◽

Tissue Changes ◽

Radiological Changes ◽

Soft Tissue Changes ◽

Hrct Temporal Bone ◽

Middle Ear Cleft

Introduction: HRCT temporal bone is the currently widely used investigation for the chronic otitis media patient especially in unsafe disease. Aim: This study was conducted to assess the condition of the middle ear in CSOM by HRCT temporal bone and compare them with intraoperative finding of the middle ear cleft . Method: Study group includes patients of Attico-antral variety of CSOM presenting in ENT OPD in our institution over a period of 18 months who undergone Computed Tomography Temporal bone followed by Surgical Procedure. Results: After study it was observed that CT scan can reliably detect bony & soft tissue changes in middle ear and intracranial complication. It can detect soft tissue in the middle ear but can not differentiate between soft tissue and cholesteatoma. Conclusion: CT scan provides excellent anatomical details and pathological changes of the ear and mastoid. Scanning all the patients is not feasible and justified, so we need to select patients in whom diagnosis and extend of the diseases is in doubt.

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Evaluation of graft taking and hearing threshold after tympanoplasty

Journal of Otolaryngology-ENT Research ◽

10.15406/joentr.2020.12.00453 ◽

2020 ◽

Vol 12 (1) ◽

pp. 37-44

Author(s):

Ehab Taha Yaseen ◽

Ali Mohamed Abdul Qader ◽

Adnan Qahtan Khalaf ◽

Ali Zeno Thanoon

Keyword(s):

Hearing Loss ◽

Middle Ear ◽

Hearing Threshold ◽

Type I ◽

Type Ii ◽

Radical Mastoidectomy ◽

Suppurative Otitis Media ◽

Type Iii ◽

Cortical Mastoidectomy ◽

Modified Radical Mastoidectomy

Background: Tympanoplasty is one of the surgical procedures mainly aimed to restoring the hearing loss and eradication of chronic middle ear diseases. Aim: To evaluate the hearing threshold preoperatively and postoperatively in patients who were subjected to tympanoplasty procedures. Patients and methods: This prospective study included 27 patients attended ENT department of AL-Yarmouk Teaching Hospital ,from February -2017 to October- 2018 , The age of patients between (10-60 years) of both gender . they presented with hearing loss as a result of chronic suppurative otitis media. After full assessment and proper preparation , They underwent Tympanoplasty procedure through post auricular incision using underlay temporalis fascia graft , The type of Tympanoplasty procedure was planned according to the status of the middle ear and ossicular chain .To eradicate disease from both the mastoid and middle ear cavity procedure and could be combined with mastoidectomy, Patients were evaluated preoperatively and followed up for 6 months postoperatively, pure Tone Audiogram was done to asses the change in hearing. Results: The study included 27 patients, (74.06%) of them were the age group between (21–40) years , the least number of patients were younger than 21 years and older than 51 years , 16 females (59.3%) and 11 males (40.7%) , Patients were classified according to tympanoplasty procedures into five groups : (Group1):10 patients (37.03%) underwent only Type I tympanoplasty. (Group2): 11 patients (40.7%) Type I with Cortical Mastoidectomy. (Group3): 2 patients (7.4%) Type II with Cortical Mastoidectomy. (Group4): 3 patients (11.1%) Type III with Cortical Mastoidectomy (Group5): one patient (3.7%) Type III with Modified Radical Mastoidectomy. They had a mean Air-Bone gap improvements were (9.66 dB), (17.4 dB), (13.2 dB), (9.60 dB) and (5.54 dB) respectively. The overall graft success rate was (92.5%). Conclusion: Significant improvement was noted in the subjective symptom of hearing loss following the tympanoplasty procedures. The mean Air-Bone gap closure was greatest for type I with cortical mastoidectomy; followed by type II with Cortical Mastoidectomy, type I alone and then type III with Cortical Mastoidectomy. Modified radical mastoidectomy was associated with the least hearing improvement as otherwise.

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Isolated Congenital Mastoid Cholesteatoma with no Involvement of Aditus Ad Antrum and Middle Ear

Clinical Medicine Insights Case Reports ◽

10.1177/11795476211014032 ◽

2021 ◽

Vol 14 ◽

pp. 117954762110140

Author(s):

Pace Annalisa ◽

Iannella Giannicola ◽

Rossetti Valeria ◽

Messineo Daniela ◽

Visconti Irene Claudia ◽

...

Keyword(s):

Soft Tissue ◽

Middle Ear ◽

Mastoid Process ◽

Reference List ◽

Digastric Muscle ◽

Diagnostic Features ◽

Imaging Evaluation ◽

Stylomastoid Foramen ◽

Congenital Origin ◽

Mastoid Region

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.

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Micro-CT imaging of Thiel-embalmed and iodine-stained human temporal bone for 3D modeling

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00522-0 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Sebastian Halm ◽

David Haberthür ◽

Elisabeth Eppler ◽

Valentin Djonov ◽

Andreas Arnold

Keyword(s):

Soft Tissue ◽

Temporal Bone ◽

Middle Ear ◽

3D Modeling ◽

Soft Tissues ◽

Ct Imaging ◽

Micro Ct ◽

Data Set ◽

Iodine Staining ◽

Tissue Structures

Abstract Introduction This pilot study explores whether a human Thiel-embalmed temporal bone is suitable for generating an accurate and complete data set with micro-computed tomography (micro-CT) and whether solid iodine-staining improves visualization and facilitates segmentation of middle ear structures. Methods A temporal bone was used to verify the accuracy of the imaging by first digitally measuring the stapes on the tomography images and then physically under the microscope after removal from the temporal bone. All measurements were compared with literature values. The contralateral temporal bone was used to evaluate segmentation and three-dimensional (3D) modeling after iodine staining and micro-CT scanning. Results The digital and physical stapes measurements differed by 0.01–0.17 mm or 1–19%, respectively, but correlated well with the literature values. Soft tissue structures were visible in the unstained scan. However, iodine staining increased the contrast-to-noise ratio by a factor of 3.7 on average. The 3D model depicts all ossicles and soft tissue structures in detail, including the chorda tympani, which was not visible in the unstained scan. Conclusions Micro-CT imaging of a Thiel-embalmed temporal bone accurately represented the entire anatomy. Iodine staining considerably increased the contrast of soft tissues, simplified segmentation and enabled detailed 3D modeling of the middle ear.

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